Evaluation of the therapeutic effect of TAE on primary liver cancer

Fatigue patterns and correlates in male liver cancer patients receiving transcatheter hepatic arterial chemoembolization

Liver cancer is a leading cancer in Taiwan, especially in males. Transcatheter arterial chemoembolization (TACE) is a major treatment for these patients, but research examining their fatigue experiences is limited. The purposes of this longitudinal, correlational study were to identify (1) changes in fatigue, symptom distress, anxiety and depression in cancer patients across four time points during the first week of TACE treatment, and (2) factors predicting changes in fatigue across the four time points. Eligible male inpatients with liver cancer were recruited from a medical center in Taipei. Subjects (n=40) were assessed 1 day before (T1), and during days 2 (T2), 4 (T3) and 6 (T4) of TACE. Data were analyzed by descriptive statistics, Pearson's correlations, repeated measures analysis of variance (ANOVA) and the generalized estimating equation (GEE). Subjects had mild to moderate levels of fatigue that peaked at T2, and showed a decrease at T3 and T4 but were still slightly higher than at T1. The GEE analysis showed that greater symptom distress, anxiety and depression, higher Adriamycin dosage, longer duration of previous fatigue, and less education significantly predicted fatigue changes. The results indicate that the pattern of fatigue in TACE during the first week is similar to fatigue in patients receiving chemotherapy. The results also further indicate that fatigue is associated to several factors. The causal relationships between fatigue and these related factors should be examined. Interventions targeting these factors should also be tested in future studies.

Hepatocellular carcinoma after systemic chemotherapy: gadolinium-enhanced mr measurement of necrosis by volume histogram

As a preliminary study, we measured the necrosis of advanced hepatocellular carcinoma (HCC) by volume histogram after systemic chemotherapy and correlated it with clinical data. Five patients with advanced HCC secondary to chronic hepatitis and cirrhosis underwent pretreatment and posttreatment MR examination on a 1.5 T MR scanner following systemic chemotherapy. MR sequences included dynamic enhanced fast spoiled gradient echo 3D images. Clinical response to chemotherapy, as determined by MR images, was measured as changes of both the total tumor volume and the percent of tumor necrosis by volume histogram algorithm. Four of five patients had clinical improvement. Three of these patients had no or minimal change of tumor volume; however, there was an increase in tumor necrosis in follow-up MR image. One patient of five with no change in tumor necrosis had no response and died at 3 months. Serial MR images showed increased irregular necrosis of advanced HCC after systemic chemotherapy, but stable volume, in patients who responded clinically to systemic chemotherapy.

Malignant hepatic tumors: changes on MRI after hepatic arterial chemoembolization--preliminary findings

This study describes the MR appearances of malignant hypervascular liver lesions pre- and post-hepatic-arterial chemoembolization, with correlation to serial imaging and clinical responses. Eight patients with malignant hypervascular liver lesions underwent pretreatment and posttreatment MR examination on a 1.5-T MR imager. MR sequences included T1-weighted spoiled gradient echo (SGE), T2-weighted fat-suppressed spin echo or turbo spin echo, and dynamic gadolinium-enhanced SGE images. All patients underwent pretreatment, initial posttreatment, and subsequent posttreatment MR studies. The histology of primary tumors included various types of hepatocellular carcinoma (HCC) (four patients: fibrolamellar HCC [one patient], HCC [two patients], mixed HCC/cholangiocarcinoma [one patient]) and liver metastases (four patients: untyped islet cell tumor [two patients], gastrinoma [one patient], carcinoid [one patient]). Response to chemoembolization was determined by three assessments: MR response, serial imaging response, and clinical response. The appearance of MR response to chemoembolization was determined based on the correlation with clinical and serial imaging response. The MR response of lesions that showed good clinical response included: increase in signal intensity on T1-weighted images (three patients), decrease in signal intensity on T2-weighted images (three patients), and negligible or minimal enhancement on immediate postgadolinium images (four patients) after chemoembolization. The most marked change in lesion appearance was observed in lesions < or = 1 cm, which had intense homogeneous enhancement on pretreatment MR studies and negligible enhancement on initial posttreatment MR examinations. MR response of lesions that showed moderate clinical response demonstrated a variety of lesion appearances from substantial change to minimal change. MR response of lesions that showed poor clinical response demonstrated no change in lesion appearances compared with the pretreatment MR study. Our results demonstrated change in appearance of liver lesions between pre- and post-hepatic-arterial chemoembolization MR studies. MR response correlated with response determined by serial imaging studies and clinical findings.